Do planejamento à ação: teoria e realidade da atividade gerencial nos serviços de atenção primária à saúde - o caso de Ribeirão das Neves

Abstract

Planning is a theme presented nowadays as an important management tool in the health area. Its development follows the administrative reform changes as well as the transference of decision-making responsibility to the lower levels of public organizations. This is a scenario where is increasing the number of courses, training and technologies related to the theme. It was detected, through the discourse of primary care manager of Ribeirão das Neves municipal district that such courses were based at the assumption that the manager does not plan her actions. Meanwhile, from the point of view of this manager, what happens is called to plan while doing. The current questions about this assertion lead to explore the problem about the existence of planning activity and its related difficulties. We tried to identify the propitiating and inhibiting factors, the strategies created by workers to deal with the difficulties of planning process; and to evidence empirical situations that could explain what the manager described as "plan while doing". Those objectives guided the realization of this qualitative, descriptive and exploratory research, unfolded by an empirical case study. The research field was Health´s Secretariat of Ribeirão das Neves municipal district, in Minas Gerais state. The subject of this study were composed by the primary care manager of the municipality 2008-9 and the people manager kept interactions during the time of the research. These people were selected for convenience, availability and relationship with the object of study. According to the results obtained, planning elaboration is hampered by changes in management positions and consequent lack of managers experience, added to the nature of managerial work, which involves brevity, variability and fragmentation of tasks. Planning operations faces well known problems related to lack of financial and human resources, but it is also presented by not trivial situations, involving both the monitoring teams and the patient registration, which creates the need to deal with uncertainty and unpredictability. Planning implementation faces unexpected obstacles related to interference of external factors regarding the nature, as the rain season anticipation, and incidents involving episodes of violence in the municipality. In addition, the procedures derived from general institutional decisions which do not consider local restrictions, prosecuted new problems. Besides, the creation of Supervisor Regional function corroborated the rise of ascendant strategies end its favoring aspects. The accomplishment of planning stages described by literature was evidenced as much as its positive effect. During the facing of known situations, strategies could be developed and formalized through negotiations between sectors. The temporal ruptures during the execution of what was planned (inherent to management activity) does not necessarily imply the absence of a plan, but it means that there is a dynamic redirection of situated action (plan while doing) caused by real-world events.